| NPI | 1417456385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANNETTE GUERRERO Practice Manager 208-391-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID O-1094) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID O-1094) |
| 207ND0900X Dermatology, Dermatopathology (Licence: ID O-1094) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: ID O-1094) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: ID O-1094) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: ID O-1094) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |